Lactation consultants can boost breastfeeding

NEW YORK (Reuters Health) - Having access to even a few
hours with a professional specially trained to help women
breastfeed may raise the number of women who start breastfeeding
and stick with it, according to a new study.

Lactation consultants are certified through the
International Board of Lactation Consultant Examiners and may
work in hospitals, offices or public health programs.

Women in the new study who spent an average total of three
hours with a lactation consultant were almost three times more
likely to start breastfeeding their newborns and to still be
breastfeeding three months later.

The American Academy of Pediatrics and the World Health
Organization recommend exclusive breastfeeding for all babies'
first six months. In reality, at least 25 percent of babies in
the U.S. are never breastfed at all, according to the Centers
for Disease Control and Prevention.

As the amount of a baby's nourishment coming from
breastfeeding increases, and the length of time its mother
breastfeeds grows, baby's risk of pneumonia, colds, leukemia and
throat and ear infections goes down, author Karen Bonuck told
Reuters Health.

Bonuck, a professor of family and social medicine and of
obstetrics & gynecology and women's health at Albert Einstein
College of Medicine in New York City, led the investigation.

Many factors influence whether or not a mother breastfeeds,
she said.

"Right after birth, there are often difficulties with
positioning the infant and knowing they are drinking enough,"
Bonuck said. "Hospital help is great, when a nurse has long
enough to spend with you, but they often don't."

When mothers get home, few have the energy to seek out
breastfeeding resources in the community, she said. Long term,
many women are still uncomfortable breastfeeding in public and
may not have the time or opportunity to pump milk when they
return to work or school.

For the study, Bonuck and her team conducted two clinical
trials, one among low-income women and one among more
economically diverse women. Participants were primarily Hispanic
and black, and two-thirds were overweight or obese.

For the first trial, half of the women had pre- and
postnatal lactation consultant visits and their doctors were
reminded by electronic prompts to speak to the patients about
breastfeeding during office visits. The other half of the women
just got usual prenatal care.

Among the women who received extra attention to
breastfeeding, 16 percent were feeding their babies only with
breast milk at three months of age, compared to 6 percent of the
women who got no extra attention.

The second trial included four groups of women: one with
lactation consultants, one with electronic prompts for doctors,
one with both interventions and one with neither. The women who
only got electronic prompts to their doctors didn't seem to
breastfeed any more than the comparison group, but those who got
lactation consultants or consultants plus electronic prompts
did.

Twenty percent of the women who had lactation consultants
only were frequently breastfeeding at three months, compared to
17 percent of those who got the consultant and electronic
prompts and only 8 percent in the comparison group, Bonuck's
team reports in the American Journal of Public Health.

Even though most of the women were overweight or obese, a
population that usually has particular difficulty breastfeeding,
according to Bonuck, lactation consultants did seem to make a
measurable difference.

Expectant moms can visit the website of the International
Lactation Consultant Organization to find a consultant nearby,
Bonuck said.

According to Rebecca L. Mannel, director of lactation
services at the University of Oklahoma Health Sciences Center in
Oklahoma City, lactation consultants "are the only healthcare
professional specifically trained to manage the full spectrum of
breastfeeding, from prenatal to postpartum, from normal healthy
moms and babies to complicated situations involving maternal
risk factors or illness or infants born preterm or with some
other health complication."

Ideally, consultants should be available for women before
giving birth and immediately after, not only to help them
navigate the physical ins-and-outs of breastfeeding, but to talk
through any misconceptions, family or social support needs and
make a plan for incorporating breastfeeding into a return to
work plan, said Mannel, who was not involved in the new study.

"They should be a standard member of the health care team
when it comes to pregnancy, childbirth and infant growth and
development," she added.

Most mothers don't have easy access to lactation
consultants, since hospitals are rarely staffed adequately,
Mannel said. Hospitals tend to treat the consultants as luxury
items and not necessities, she said.

"While other prenatal providers, including nursing staff can
provide some of the basic breastfeeding education to prepare
women for the hospital experience and initiation of
breastfeeding, this does not happen consistently," Mannel said.
"Other prenatal care providers have multiple issues they need to
address with pregnant women and breastfeeding is easy to put off
and ultimately not address."

One of the biggest barriers to accessing lactation
consultants, Mannel said echoing the study authors, is insurance
coverage. The Patient Protection and Affordable Care Act,
commonly called Obamacare, requires coverage of lactation care
but does not specify who should provide the care or how many
times a mother can access it.

"Many insurance companies haven't changed anything, other
than to say mom can go the MD or nurse practitioner for
breastfeeding care - who are often not adequately trained to
provide care for breastfeeding difficulties or complications,"
Mannel said.

SOURCE: http://bit.ly/JkRRBB American Journal of Public
Health, online December 19, 2013.

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